The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. AEM Feb 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and Assistant Professor at the University of Calgary. Date: February 17, 2023 Reference: Gettel et al.

Emergency Department 130

Emergency Department ALS ED EMS 130

EMergucate

JULY 11, 2013

A 53 year old male presents to your Emergency Department following an episode of collapse and this ECG.

Emergency Department 100

Emergency Department EMS 100

EMergucate

AUGUST 9, 2013

A 83 year old patient presents to your Emergency Department complaining of lethargy, nausea, and vomiting. This is his ECG.

Emergency Department 100

Emergency Department EMS 100

EMergucate

SEPTEMBER 8, 2013

A 47 yr old female with a history of cardiac failure presents to your emergency department with an unrelated injury, … Continue reading →

Emergency Department 100

Emergency Department EMS 100

EMergucate

DECEMBER 26, 2013

Following on from last week, this 58 yr old male is brought to your Emergency Department following an out-of-hospital cardiac … Continue reading →

Emergency Department 100

Emergency Department EMS 100

The Skeptics' Guide to EM

OCTOBER 20, 2018

Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. She presents to the emergency department with chest pain and some shortness of breath. Case: A 64-year-old woman with type-2 diabetes.

Coronary 181

Coronary Emergency Department ALS OR 181

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. Emerg Radiol. 2013 Aug;20(4):337-9.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

ALiEM

NOVEMBER 10, 2023

A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. 2013 Apr;168(4):726-32. Epub 2013 Feb 16. Progression stopped after discontinuing TMP-SMX. Br J Dermatol. doi: 10.1111/bjd.12133.

Emergency Department 161

Emergency Department OR 161

Core EM

JANUARY 25, 2024

An estimated 7% to 15% of acutely hospitalized psychiatric patients and psychiatric emergency department patients exhibit catatonia [4]. Catatonia: a case report by Brown Emergency Medicine. Epidemiology : Who typically suffers from catatonia? Severely ill patients with an underlying psychiatric or medical disorder.

MICU 246

MICU Emergency Department ED OR 246

The Skeptics' Guide to EM

AUGUST 28, 2021

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED?

ED 130

ED Emergency Department ALS OR 130

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. The time interval referred to as ED boarding time has been part of the hospital’s required data submission to CMS since 2013. ED boarding.

Emergency Department 52

Emergency Department ED EMS ALS 52

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). Case: A 67-year-old male presents to the emergency department obtunded with left hemiplegia. Symptoms began just prior to presentation.

EMS 186

EMS ALS Emergency Department OR 186

EMOttawa

FEBRUARY 22, 2024

Lacerations are a common presenting complaint to emergency department. In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% of ED visits(1).

Emergency Department 93

Emergency Department ED OR 93

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Anatomy, Shoulder and Upper Limb, Radial Nerve. 2023 Nov 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. 2018 Jun;54(6):849-854. doi: 10.1016/j.jemermed.2018.02.011.

E-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. 2013 Mar;34(3):115-24; quiz 125. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. Pediatric neck masses.

ACS 161

ACS Emergency Department ED OR 161

ALiEM

DECEMBER 18, 2023

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. 2013 Jun;6(6):31-7. Two days prior to presentation she began to experience fevers with a Tmax of 103°F. The patient endorsed associated pruritus and cervical lymphadenopathy with the rash.

Emergency Department 177

Emergency Department OR 177

Pediatric EM Morsels

OCTOBER 27, 2023

Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Int J Emerg Med. J Emerg Med.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

Pediatric EM Morsels

MAY 24, 2024

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 2013 Aug 1;167(8):700-707. Lancet Child Adolesc Health. 2024;8:339-344. Miglioretti DL, Johnson E, Williams A, et al. JAMA Pediatr. 2013.311.

ALS 164

ALS EMS Emergency Department OR 164

The Skeptics' Guide to EM

DECEMBER 15, 2018

During winter periods a typical emergency department may well see a child a day presenting with a febrile seizure There was a SRMA by Rosenbloom et al. ( Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children.

OR 130

OR Emergency Department ALS 130

The Skeptics' Guide to EM

MAY 14, 2022

Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine. His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

APRIL 24, 2021

Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

JANUARY 19, 2019

He is alert and oriented times three with normal vital signs by the time he arrives in the emergency department. Wave 3: Significant increase in overdose deaths involving synthetic opioids (like illicitly-manufactured or prescribed fentanyl) beginning in 2013 [4]. . Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

The Skeptics' Guide to EM

OCTOBER 28, 2017

That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. There are certain patient populations who are at risk for in adequate pain management. The pediatric age group represents one of the populations at risk for oligoanalgesia.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

JANUARY 11, 2025

Stercoral colitis in the emergency department: a review of the literature. International journal of emergency medicine, 17(1), 3. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Annals of emergency medicine, 82(1), 3746. Stercoral Colitis.

E-9-1-1 97

E-9-1-1 EMS Emergency Department OR 97

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

This was the third time coming to McGill University Department of Emergency Medicine to give Grand Rounds. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. The bottom line was this was interesting, but VSE protocol was not ready for routine use.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

ALiEM

MARCH 7, 2024

Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on Emergency Department workflow and length of stay (Table 1). Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 J Emerg Med 2013; 44 (4): 764-772. Optimizing Emergent Surgical Cricothyrotomy for Austere Environments. Emergency Medicine Practice.

Frozen Plasma 101

Frozen Plasma Allergic Reaction FFP Plasma 101

The Skeptics' Guide to EM

OCTOBER 3, 2020

Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. She is the creator of the HEART Score and an enthusiastic researcher. Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al.

Emergency Department 100

Emergency Department ALS OR 100

FOAMfrat

DECEMBER 26, 2024

IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. These showed that with 22 incidents between 2011 and 2013, 43 people were harmed. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES.

Epinephrine 116

Epinephrine First Responder OR Emergency Management 116

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? An implementation science approach improves language access in the emergency department. Department of Health and Human Services, Office of Civil Rights. The limited English proficiency population in the United States in 2013. 45:446-458.

Emergency Department 103

Emergency Department ALS E-9-1-1 ED 103

The Skeptics' Guide to EM

MARCH 10, 2018

We will summarize some of the recommendations for emergent anticoagulation reversal in the emergency department in the show notes. Zahed et al did a randomized control trial (RCT) in 2013 on using TXA for the treatment of anterior epistaxis [2]. It made sense to look at it for the treatment of epistaxis.

Emergency Department 100

Emergency Department ALS Coronary OR 100

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Emergency department overcrowding is a complex issue with multiple contributing factors. Learning about international trends sparked our curiosity about our own department.

Emergency Department 89

Emergency Department ALS ED OR 89

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Annals of Emergency Medicine 2014. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013.

ALS 100

ALS Emergency Department OR 100

The Skeptics' Guide to EM

MARCH 13, 2021

Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ).

ALS 100

ALS Emergency Department ED OR 100

EMDocs

SEPTEMBER 23, 2023

A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. ECGpedia , 22 May 2013, [link]. Patients should be counseled to avoid triggers such as fever, alcohol, and certain medications that may precipitate arrhythmias. Heart Rhythm. 2013;10(12):1932-1963.

E-9-1-1 104

E-9-1-1 EMS ALS Defibrillator 104

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. Published 2013 Aug 15. Which one do you select? 2013;9(1):30.

ED 105

ED Life Support Advanced Life Support CPR 105